Canal wall down mastoidectomy and tympanoplasty in cholesteatoma surgery: ten years’experience

Tympanomastoid surgery for cholesteatoma is a procedure designed to eliminate thedisease and maintain a safe and dry ear. This retrospective study was designed toevaluate the functional results of cholesteatoma patients who underwent canal walldown mastoidectomy in conjunction with a tympanoplasty. Operated ears due tochronic otitis media with cholesteatoma were considered for the study. The studywas carried out in 120 ears. The choice of technique for tympanoplasty is based onthe pathology encountered in the stapes superstructure. Patients were divided intothree: 1) Group A, a type II TPL with stapes columella reconstruction; 2) Group B, atype III TPL with major columella reconstruction; and 3) Group C, a type IV TPLusing a temporalis fascia and thick cartilage to shield the round window. The operatedears of Groups A and B, as compared to Group C, presented a significant decreasein the pre-operative Air-bone gap and an increase in the number of operatedears with an Air-bone gap between 0 - 20 dB. The study emphasizes the importanceof functional separation of the two acoustic windows by fascia and cartilage graftwhen the stapes superstructure is missing but the footplate is mobile.